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Cushing's Syndrome

(Cushing's Disease; Hypercortisolism)
  • Definition

    Cushing's syndrome is a hormone disorder. Cortisol, in normal doses, helps the body manage stress and infection. However, these high levels over a long period of time can cause several health problems.
  • Causes

    Cushing's syndrome is caused by extended exposure to a hormone called cortisol. Prolonged or excess exposure to cortisol may be caused by:
    • Long-term use of corticosteroid hormones such as cortisone or prednisone
    • Excess production of cortisol by:
      • Tumor or abnormality of the adrenal gland.
      • Tumor or abnormality of the pituitary gland. In the case of a pituitary tumor, it is called Cushing's disease
      • Rarely, tumors of the lungs, thyroid, kidney, pancreas, or thymus gland.
    Pituitary and Adrenal Glands
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  • Risk Factors

    Factors that may increase your chance of Cushing's syndrome include:
  • Symptoms

    Cushing's syndrome may cause:
    • Weight gain of the upper body and trunk
    • Rounded face
    • Severe fatigue or muscle weakness
    • Easily bruised, thinner skin
    • Purple stretch marks
    • Excess hair growth or acne in women
    • Menstrual disorders, especially infrequent or absent periods
    • Reduced fertility and interest in sex
    • Personality changes or mood swings
  • Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. Tests may be done to determine the level of cortisol and find a cause.
    Tests for cortisol levels may include:
    • 24-hour urinary free cortisol level
    • Late-evening cortisol saliva/blood level
    • Dexamethasone suppression test
    Tests to determine the cause of Cushing's Syndrome may include:
    • Blood test for adrenocorticotropin hormone (ACTH) level
    • High-dose dexamethasone suppression test
    Other tests may help to see if there is a tumor on the pituitary or adrenal glands. Images may be taken with:
  • Treatment

    Treatment of Cushing's syndrome depends on the cause. Talk with your doctor about the best treatment plan for you. Options include:
    • Surgical removal of tumor
    • Surgical removal of part, all, or both adrenal glands
    • Radiation therapy for some persistent tumors
    • Gradual withdrawal of cortisone-type drugs under close medical supervision
    • Drugs that decrease cortisol production or block the functioning of other adrenal products
  • Prevention

    Work with your doctor to keep your use of corticosteroid drugs to a minimum.

    Cushing's Support and Research Foundation

    Family Doctor—American Academy of Family Physicians


    Health Canada

    The College of Family Physicians of Canada


    Arnaldi G, Angeli A, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinolo Metabo. 2003;88:5593-5602.

    Cushing disease. EBSCO DynaMed website. Available at: . Updated February 21, 2014. Accessed February 27, 2014.

    Cushing's syndrome. National Endocrine and Metabolic Diseases Information Service website. Available at: Updated April 6, 2012. Accessed February 27, 2014.

    Diez JJ, Iglesias P. Pharmacological therapy of Cushing’s syndrome: drugs and indications. Mini Rev Med Chem. 2007;7(5):467-480.

    Kirk LF Jr, Hash RB, et al. Cushing's disease: clinical manifestations and diagnostic evaluation. Am Fam Physician. 2000;62(5):1119-1127, 1133-1134.

    Tritos NA, Biller BM, et al. Management of Cushing disease. Nat Rev Endocrinol. 2011;7(5):279-289.

    Makras P, Toloumis G, et al. The diagnosis and differential diagnosis of endogenous Cushing’s syndrome. Hormones. 2006;5:231-250.

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